CUA

The Catholic University of America

National Catholic School of Social Service, Office of Field Education

Washington, DC 20064

Phone 202-319-5457

EARLY ASSESSMENT: Advanced Year Clinical/Clinical Health/Clinical Military

Check one: __ Clinical __Clinical Health __ Clinical Military

Student Name ______Date ______

Field Instructor ______Agency ______

Integrative Seminar instructor/Field Liaison ______

This mid-semester evaluation assesses the student's performance to date. Our expectation is that students will receive ratings of Yes in all Essential Professional Behaviors. In the fall semester, if a student receives ratings of No in any of the 4 Essential Professional Behaviors, or more than 3 scores of 1 in the practice behaviors, the field liaison will set up a visit to develop an intervention plan. An intervention plan should address each essential professional behavior or practice behavior that is of concern.

Essential Professional Behaviors / Yes / No
1.  Student reports to field on time.
2.  Student attends field regularly.
3.  Student is receptive and open to feedback from field instructor.
4.  Student handles absences and/or unavoidable lateness responsibly.


Is an immediate liaison visit requested? __ Yes __ No

Number of assignments:

______Individuals ______Group

______Family ______Community

______Couple ______Other (specify)


Please use the ratings below to guide your scoring – please write your score in the box to the right of the practice behavior:

1 = This practice behavior has not yet emerged as expected

2 = This practice behavior is demonstrated at a low/inconsistent level of competence

3 = This practice behavior is demonstrated at an emerging level of competence

4 = This practice behavior is demonstrated at a good level of competence

5 = This practice behavior is demonstrated at a high level of competence

NA = Not applicable to internship experience

IE = Too little experience up to this point to be able to assign any rating

BENCHMARK COMPETENCIES

I.  Identify as a PROFESSIONAL SOCIAL WORKER and conduct oneself accordingly

Practice Behavior / Rating
1.  Student practices with a clear understanding of the professional strengths, capacities, and limitations of clinical social work

II. Apply social work ETHICAL PRINCIPLES to guide professional practice.

Practice Behavior / Rating
1.  Social workers recognize and manage personal biases as they affect the clinical relationship in the service of clients’ well-being

III. Apply CRITICAL THINKING to inform and communicate professional judgments.

Practice Behavior / Rating
1.  Social workers demonstrate effective oral and written communication with clients and other professionals;

IV.  Engage DIVERSITY AND DIFFERENCE in practice.

Practice Behavior / Rating
1.  Social workers recognize and articulate to clients, and the service delivery system, the extent that societal structures and values may oppress, marginalize, and alienate, or create, enhance, and privilege different cultural groups within a society.


X. ENGAGE, ASSESS, INTERVENE, AND EVALUATE individuals, families, groups, organizations, and communities.

Practice Behaviors / Rating
Engagement
1.  use empathy, active listening, and other interpersonal skills to establish therapeutic rapport, and set treatment goals with the client system
2.  develop culturally responsive therapeutic relationships
3.  attend to the interpersonal dynamics and contextual factors that may strengthen or harm the therapeutic working alliance
Assessment
1.  use a multi-dimensional assessment, that includes bio-psycho-social-spiritual data, as well as client strengths, coping capacity, and readiness for change
2.  use differential and multi-axial diagnostic processes
3.  co-construct therapeutic goals and clinical objectives to address psychosocial distress, and engage in ongoing reassessment of those goals
Intervention Rating
1.  co-construct and select therapeutic interventions that best address the client’s presenting problem and risk factors, and use multiple intervention plans to address compound problems or complex trauma
2.  incorporate client strengths, capacities, and protective factors in the therapeutic intervention plan.
Evaluation
1.  critically analyze, monitor, and evaluate interventions
2.  adjust therapeutic intervention plans based on ongoing process evaluation

Comments:______

______

______


______

Field Instructor’s Signature Date

______

Student’s Signature Date Agree w/Evaluation: q *Disagree: q

*In the event that student does not agree with any aspect of this evaluation, he/she may append a statement describing specific disagreements and reasons for them.